Active NPI
Howard Gustafson, LCSW
- Addiction (Substance Use Disorder) Counselor
- Indianapolis, IN
National Provider Identifier
1891182713
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 87001536A
- Practice address
- 324 N Park Ave
Indianapolis, IN 46202-3632 - Phone
- (317) 714-7667
- Fax
- (317) 634-0253
- NPI assigned
- Apr 17, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 87001536A | IN | Primary |
| Clinical Social Worker | 1041C0700X | 34001491A | IN |
Addresses
Primary practice location
324 N Park Ave
Indianapolis, IN 46202-3632
Mailing address
324 N Park Ave
Indianapolis, IN 46202-3632
Phone (317) 714-7667
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 87001536A | IN | MD | Addiction (Substance Use Disorder) Counselor |
| 34001491A | IN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1429228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1429228800000",
"number": "1891182713",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "324 N PARK AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462023632",
"telephone_number": "317-714-7667",
"fax_number": "317-634-0253"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "324 N PARK AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462023632",
"telephone_number": "317-714-7667",
"fax_number": "317-634-0253"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUSTAFSON",
"first_name": "HOWARD",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-04-17",
"last_updated": "2015-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "IN",
"license": "87001536A",
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IN",
"license": "34001491A",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.